稳心颗粒联合重组人脑利钠肽治疗终末期心力衰竭的临床研究

Clinical study on Wenxin Granules combined with recombinant human brain natriuretic peptide in treatment of end-stage heart failure

目的探讨终末期心力衰竭应用稳心颗粒联合重组人脑利钠肽治疗的临床效果。方法选取2018年2月—2019年2月阿坝州人民医院收治的86例终末期心力衰竭患者,随机分为对照组(n=43)和治疗组(n=43)。对照组给予冻干重组人脑利钠肽,首先以1.5μg/kg的负荷剂量静脉冲击后,继以0.007 5μg/(kg?min)的给药速率连续静脉滴注,连用3 d后继续常规治疗。治疗组在对照组基础上口服稳心颗粒,1袋/次,3次/d,开水冲服。两组均连续治疗4周。比较两组临床疗效和呼吸困难缓解时间,治疗前后呼吸困难评分、超声心动图指标[左心室舒张、收缩末期容积(LVEDV和LVESV)及左心室射血分数(LVEF)]、血流动力学指标和血浆N末端B型利钠肽原(NT-proBNP)、C反应蛋白(CRP)、内皮素-1(ET-1)水平变化情况。结果治疗组总有效率为90.7%,显著高于对照组74.4%,两组比较差异有统计学意义(P<0.05)。治疗组呼吸困难缓解时间显著短于对照组(P<0.05);两组治疗后呼吸困难评分较治疗前均显著增高(P<0.05),且治疗组治疗后呼吸困难评分显著高于对照组同期(P<0.05)。与治疗前比较,两组治疗后LVEDV、LVESV值均显著降低(P<0.05),LVEF值则均显著升高(P<0.05);且治疗后,治疗组超声心动图参数(LVEDV、LVESV、LVEF)的改善效果均显著优于对照组同期(P<0.05)。与治疗前相比,两组治疗后心指数(CI)、心输出量(CO)及心脏收缩力指数(HI)值均显著上升(P<0.05),而舒张功能指数(O/C)、肺动脉楔压(PAWP)和总外周阻力(TPR)值均显著下降(P<0.05);但治疗后,治疗组血流动力学的改善效果更显著(P<0.05)。两组治疗后血浆NT-proBNP、CRP、ET-1水平均显著低于治疗前(P<0.05),且治疗组下降更显著(P<0.05)。结论稳心颗粒联合重组人脑利钠肽治疗终末期心力衰竭的整体疗效确切,能迅速有效地缓解患者的呼吸困难,改善心脏结构和功能,稳定血流动力学状态,正性调节血管内皮功能,减轻病情的严重程度,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Wenxin Granules combined with recombinant human brain natriuretic peptide in treatment of end-stage heart failure.Methods 86 Patients with end-stage heart failure admitted to People’s Hospital of Aba Prefecture from February 2018 to February 2019 were randomly divided into control group(n=43)and treatment group(n=43).Patients in the control group were treated with Lyophilized Recombinant Human Brain Natriuretic Peptide,intravenous impact was administered at 1.5μg/kg,followed by continuous intravenous infusion at 0.0075μg/(kg?min)for 3 days,followed by routine treatment.The treatment group was po administered with Wenxin Granules,1 bag/time,three times daily.All patients were treated for 14 days.The clinical efficacy and dyspnea relief time of the two groups were compared.The changes of dyspnea score,echocardiographic indexes(LVEDV,LVESV,and LVEF),hemodynamic indexes,NT-proBNP,CRP,and ET-1 were compared before and after treatment.Results The total effective rate of the treatment group was 90.7%,significantly higher than that of the control group 74.4%(P<0.05).The remission time of dyspnea in the treatment group was significantly shorter than that in the control group(P<0.05).The dyspnea score after treatment in both groups was significantly higher than that before treatment(P<0.05),and the dyspnea score after treatment in the treatment group was significantly higher than that in the control group at the same time(P<0.05).Compared with before treatment,LVEDV and LVESV values in both groups decreased significantly(P<0.05),but LVEF values increased significantly(P<0.05).After treatment,the improvement effect of echocardiography parameters(LVEDV,LVESV,LVEF)in the treatment group was significantly better than that in the control group(P<0.05).Compared with before treatment,the cardiac index(CI),cardiac output(CO)and cardiac contractility index(HI)of the two groups increased significantly after treatment(P<0.05),while the diastolic function index(O/C),pulmonary artery wedge pressure(PAWP)and total peripheral resistance(TPR)decreased significantly(P<0.05).However,after treatment,the hemodynamic improvement effect in the treatment group was more significant(P<0.05).The plasma levels of NT-proBNP,CRP,ET-1 in the two groups after treatment were significantly lower than before treatment(P<0.05),and the decrease in the treatment group was more significant(P<0.05).Conclusion Wenxin Granules combined with recombinant human brain natriuretic peptide has overall efficacy in treatment of end-stage heart failure,and can quickly and effectively relieve patients’dyspnea,improve cardiac structure and function,stabilize hemodynamic state,positively regulate vascular endothelial function,and reduce the severity of the disease,which has a certain clinical application value.